The objective of the study is to analyse the causes and impact of conversion from VATS to thoracotomy identifying any possible pre-operative risk factors and related consequences.
Data from patient who underwent VATS lobectomy (VATS-L) for NSCLC at VATS Group participating centres were retrospectively analysed and divided in two groups: patients treated with VATS-L and patients who suffered from conversion. Predictors of conversion were assessed with univariate and multivariable exact logistic regression. Complications were evaluated as dependent variables of conversion in a Cox multivariable logistic regression model.
A total of 4629 patients underwent planned VATS-L for NSCLC and of these, 432 (9.3%) required conversion; the most frequent causes were bleeding (30.4%) and fibro-calcified hilar lymph nodes (23.9%). The independent risk factors at multivariable analysis model were sex male (OR 1.458, p < 0.01), age older than 70 years (OR 1.248, p = 0.036) and the clinically node-positive disease (OR 2.258, p < 0.01). The mortality rate was similar, but the percentage of patients who suffered from any complication (41.7% vs 24.4%, p < 0.01), the complication rate (65% vs 32.2%, p < 0.01), chest tube duration (p < 0.01) and the hospitalisation rate (p < 0.01) were higher for patients converted. Atrial fibrillation (OR 1.471, p = 0.019), prolonged air leak (OR 1.403, p = 0.043), blood transfusions (OR 4.820, p < 0.01), sputum retention (OR 1.80, p = 0.027) and acute kidney failure (OR 2.758, p = 0.03) were significantly associated with conversion at multivariable analysis.
Conversion is associated with increased surgical morbidity, blood loss and hospital stay. Sex male, old age and the clinical involvement of lymph nodes were the strongest predictors of conversion.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Roviaro G, Rebuffat C, Varoli F, Vergani C, Mariani C, Maciocco M (1992) Videoendoscopic pulmonary lobectomy for cancer. Surg Lasparosc Endosc 2:244–247
Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH Jr et al (2006) Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 244:420–425
Swanson SJ, Herndon JE, D’Amico TA, Demmy TL, McKenna RJ, Green MR et al (2007) Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol 25:4993–4997
Whitson BA, Andrade RS, Boettcher A, Bardales R, Kratzke RA, Dahlberg PS et al (2007) Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 83:1965–1970
Laursen L, Petersen RH, Hansen HJ, Jensen TK, Ravn J, Konge L (2016) Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg 49(3):870–875
Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole DH Jr et al (2007) Thorascopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83:1245–1249
Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hürtgen M, Petersen RH ESTS Database Committee and ESTS Minimally Invasive Interest Group et al (2016) Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 49(2):602–609
Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N et al (2005) Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 138:510–517
Gonfiotti A, Bongiolatti S, Viggiano D, Borgianni S, Borrelli R, Tancredi G, Jaus MO, Politi L, Comin CE, Voltolini L (2016) Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections? J Thorac Dis 8(12):3496–3504
Gonfiotti A, Bertani A, Nosotti M, Viggiano D, Bongiolatti S, Bertolaccini L, Droghetti A, Solli P, Crisci R, Voltolini L; Italian VATS Group (2018) Safety of lymphadenectomy during video-assisted thoracic surgery lobectomy: analysis from a national database. Eur J Cardiothorac Surg 54(4):664–670
McKenna RJ Jr (2008) Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin 18:275–280
Samson P, Guitron J, Reed MF, Hanseman DJ, Starnes SL (2013) Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg 145(6):1512–1518
Villamizar NR, Darrabie M, Hanna J, Onaitis MW, Tong BC, D’Amico TA, Berry MF (2013) Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer. J Thorac Cardiovasc Surg 145(2):514–520
Gazala S, Hunt I, Valji A, Stewart K, Bédard ER (2011) A method of assessing reasons for conversion during video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 12(6):962–964
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Non-Small Cell Lung Cancer, Version 4.2018—April 26, 2018. www.nccn.org
Hennon M, Sahai RK, Yendamuri S, Tan W, Demmy TL, Nwogu C (2011) Safety of thoracoscopic lobectomy in locally advanced lung cancer. Ann Surg Oncol 18(13):3732–3736
Yang CF, Meyerhoff RR, Mayne NR, Singhapricha T, Toomey CB, Speicher PJ, Hartwig MG, Tong BC, Onaitis MW, Harpole DH Jr, D’Amico TA, Berry MF (2016) Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg 49(6):1615–1623
Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M (2014) Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis 6(6):641–648
Gonfiotti A, Bongiolatti S, Bertolaccini L, Viggiano D, Solli P, Droghetti A, Bertani A, Crisci R, Voltolini L; Italian VATS Group (2017) Thoracoscopic lobectomy for locally advanced-stage non-small cell lung cancer is a feasible and safe approach: analysis from multi-institutional database. JOVS 3:160
Gonfiotti A, Bongiolatti S, Borgianni S, Borrelli R, Jaus MO, Politi L, Tancredi G, Viggiano D, Voltolini L (2016) Developement of a video-assisted thoracoscopic lobectomy program in a single istitution: results before and after completion of the learning curve. J Cardiothorac Surg 11(1):130
Petersen RH, Hansen HJ (2012) Learning curve associated with VATS lobectomy. Ann Cardiothorac Surg 1:47–50
Augustin F, Maier HT, Weissenbacher A, Ng C, Lucciarini P, Öfner D, Ulmer H, Schmid T (2016) Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg Endosc 30(6):2415–2421
Byun CS, Lee S, Kim DJ, Lee JG, Lee CY, Jung I, Chung KY (2015) Analysis of unexpected conversion to thoracotomy during thoracoscopic lobectomy in lung cancer. Ann Thorac Surg 100(3):968–973
Puri V, Patel A, Majumder K, Bell JM, Crabtree TD, Krupnick AS, Kreisel D, Broderick SR, Patterson GA, Meyers BF (2015) Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications. J Thorac Cardiovasc Surg 149(1):55–61, 62.e1
Flores RM, Ihekweazu U, Dycoco J, Rizk NP, Rusch VW, Bains MS, Downey RJ, Finley D, Adusumilli P, Sarkaria I, Huang J, Park B (2011) Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg 142(6):1412–1417
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
List of collaborators of the Italian VATS Group: Carlo Curcio (Monaldi Hospital, Napoli); Dario Amore (Monaldi Hospital, Napoli); Giuseppe Marulli (University of Padova); Samuele Nicotra (University of Padova); Andrea De Negri (San Martino Hospital, Genova); Paola Maineri (San Martino Hospital, Genova); Gaetano Di Rienzo (Vito Fazzi Hospital, Lecce); Camillo Lopez (Vito Fazzi Hospital, Lecce); Roberto Crisci (University Hospital L’Aquila-Teramo); Duilio Divisi (University Hospital L’Aquila-Teramo); Angelo Morelli (S. Maria delle Misericordia Hospital, Udine); Alessandro Bertani (IRCCS ISMETT-UPMC, Palermo); Emanuele Russo (IRCCS ISMETT-UPMC, Palermo); Francesco Londero (S. Maria delle Misericordia Hospital, Udine); Lorenzo Rosso (General Hospital, University of Milan, Milano); Lorenzo Spaggiari (IEO Hospital, Milano); Roberto Gasparri (IEO Hospital, Milano); Guido Baietto (Maggiore della Carita` Hospital, Novara); Caterina Casadio (Maggiore della Carita` Hospital, Novara); Maurizio Infante (Borgo Trento Hospital, Verona); Cristiano Benato (Borgo Trento Hospital, Verona); Marco Alloisio (IRCCS Humanitas, Milano); Edoardo Bottoni (IRCCS Humanitas, Milano); Andrea Droghetti (Carlo Poma Hospital, Mantova); Andrea Giovanardi (Carlo Poma Hospital, Mantova); Giuseppe Cardillo (Forlanini Hospital, Roma); Francesco Carleo (Forlanini Hospital, Roma); Luca Bertolaccini (Maggiore Teaching Hospital, Bologna); Piergiorgio Solli (Maggiore Teaching Hospital, Bologna); Franco Stella (S. Orsola Hospital, Bologna); Giampiero Dolci (S.Orsola Hospital, Bologna); Francesco Puma (University of Perugia); Damiano Vinci (University of Perugia); Giorgio Cavallesco (University of Ferrara); Pio Maniscalco (University of Ferrara); Desideria Argnani (AUSL Romagna Hospital Forli); Luca Ampollini (University of Parma); Paolo Carbognani (University of Parma); Alberto Terzi (Negrar Hospital, Verona); Andrea Viti (Negrar Hospital, Verona); Giampiero Negri (S. Raffaele Hospital, Milano); Alessandro Bandiera (S. Raffaele Hospital, Milano); Reinhold Perkmann (Bolzano Hospital, Bolzano); Francesco Zaraca (Bolzano Hospital, Bolzano); Mohsen Ibrahim (S. Andrea Hospital, Roma); Camilla Poggi (S. Andrea Hospital, Roma); Felice Mucilli (S. Maria Annunziata Hospital, Chieti); Pierpaolo Camplese (S. Maria Annunziata Hospital, Chieti); Luca Luzzi (University of Siena); Marco Ghisalberti (University of Siena); Andrea Imperatori (University of Varese); Nicola Rotolo (University of Varese); Luigi Bortolotti (Humanitas Gavazzeni Hospital, Bergamo); Giovanna Rizzardi (Humanitas Gavazzeni Hospital, Bergamo); Massimo Torre (Niguarda Hospital, Milano); Alessandro Rinaldo (Niguarda Hospital, Milano); Armando Sabbatini (Ospedali Riuniti, Ancona); Majed Refai (Ospedali Riuniti, Ancona); Mauro Roberto Benvenuti (Spedali Civili, Brescia); Diego Benetti (Spedali Civili, Brescia); Alessandro Stefani (Ospedale Policlinico, Modena); Pamela Natali (Ospedale Policlinico, Modena); Paolo Lausi (Ospedale Molinette, Torino); Francesco Guerrera (Ospedale Molinette, Torino).
Stefano Bongiolatti, Alessandro Gonfiotti, Domenico Viggiano, Sara Borgianni, Leonardo Politi, Roberto Crisci, Carlo Curcio and Luca Voltolini have no conflicts of interest or financial ties to disclose.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bongiolatti, S., Gonfiotti, A., Viggiano, D. et al. Risk factors and impact of conversion from VATS to open lobectomy: analysis from a national database. Surg Endosc 33, 3953–3962 (2019). https://doi.org/10.1007/s00464-019-06682-5
- Video-assisted thoracic surgery
- Lung cancer